The role of food safety in child survival programmes

Editor – The article by F.F. Fikree et al. (1) reports that diseases of infectious etiology (diarrhoea and ARI) were the leading clinical causes of death in the post-neonatal period with diarrhoea being responsible for 43.3% of all deaths. The authors conclude that child survival programmes must therefore maintain and strengthen their strategies for prevention and control of these infections. As far as diarrhoea is concerned, the wide use of oral rehydration salts will certainly be successful in helping to reduce mortality. However, in order to reduce morbidity, the causes of infant diarrhoea need to be elucidated.

Despite the fact that three successful prevention strategies (i.e. breastfeeding, immunization, drinking-water and sanitation) have been strongly promoted in the past, surveys of diarrhoeal diseases indicate that these interventions have not been fully effective in preventing diarrhoeal diseases in infants and young children (2, 3). On the other hand, there is strong evidence that food and poor food handling practices play a major role in the transmission of diarrhoea. Is it perhaps possible that the child survival programmes are incomplete, and need to be complemented by measures to assure the safety of the complementary food (weaning food) given to the infants? After all, diarrhoea is caused by pathogens that need to enter the child's body through the mouth. Since complementary food contains substances that are not only nutritious for the child but support the growth of bacterial pathogens, regarding food as a vehicle of transmission of pathogens appears to be logical. In 1993, the Bulletin published an article that suggested contaminated food was a major cause of diarrhoea and associated malnutrition among infants and children (4). The role of food in the epidemiology of diarrhoea had also been recognized by the 1992 Joint FAO/WHO International Conference on Nutrition (5).

The results published by Fikree suggest that this link ought to be considered and the prevention strategies appropriately amended to include food safety. In 1996 WHO issued Basic Principles (6) for the safety of complementary food. What is needed is their vigorous implementation.


Fritz Käferstein1

Conflicts of interest: none declared.

1. Fikree F, Azam SI, Berendes HW. Time to focus child survival programmes on the newborn: assessment of levels and causes of infant mortality in rural Pakistan. Bulletin of the World Health Organization 2002;80:271-7.

2. Bern C, Martines J, de Zoya I, Glass RI. The magnitude of the global problem of diarrhoeal disease: a ten-year update. Bulletin of the World Health Organization 1992;70:705-14.

3. F. Käferstein. Food safety: Fourth pillar in strategy to prevent infant diarrhea. Voices from the city. Washington (DC): US Agency for International Development; 1997. Newsletter on Urban Environmental Health Issues.

4. Motarjemi Y, Käferstein F, Moy G, Quevedo F. Contaminated weaning food a major risk factor in the cause of diarrhoea and associated malnutrition. Bulletin of the World Health Organization 1993;71:79-92.

5. International Conference on Nutrition – a challenge to the food safety community. Geneva: World Health Organization; 1996. WHO document WHO/FNU/FOS/ 96.4.

6. Basic principles for the preparation of safe food for infants and young children. Geneva: World Health Organization; 1996. WHO document WHO/FNU/FOS/96.6.



International Food Safety Consultant, Member of the Expert Advisory Panel on Food Safety of the World Health Organization, 4–6 chemin du Midi, 1260 Nyon, Switzerland (email: dfkaferstein@bluewin.ch).

World Health Organization Genebra - Genebra - Switzerland